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Recent research and thinking on H ealth P olicy & Systems. Devaki Nambiar PhD, Kabir Sheikh MBBS MPH PhD Health Governance Hub Public Health Foundation of India 4 th Technical Review Meeting for the HPHFKH 10 th October 2011. PHFI’s health Governance hub. PHFI’s Health Governance Hub.

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recent research and thinking on h ealth p olicy systems

Recent research and thinking on Health Policy & Systems

DevakiNambiarPhD, Kabir Sheikh MBBS MPH PhD

Health Governance Hub

Public Health Foundation of India

4th Technical Review Meeting for the HPHFKH

10th October 2011

phfi s health governance hub1
PHFI’s Health Governance Hub

A team of researchers across our family of institutions in five cities

Core interest in the relationship between health systems governance and social justice

THEME AREAS

Regulation and stewardship

Community action for health

Health workforce governance

Pharmaceutical policy

Urban health governance

Public health philanthropy

As India moves towards Universal Health Coverage…

project mapping the health regulatory architecture in lmic mixed systems
PROJECT: MAPPING THE HEALTH REGULATORY ARCHITECTURE IN lmic mixed systems

Sheikh, Saligram, Prasad (2010-2011)

Funding: Nossal Institute

regulatory framework
Regulatory Framework
  • Normative position:
    • Regulation as a means to health equity, health rights, development (Mackintosh 2007)
  • Approach:
    • Backward Mapping: ‘bottom up’ understanding of field level phenomena generate policy needs (Elmore 1982)
  • Process:
  • Regulatory targets identified from in-depth literature review on LMIC ‘mixed’ health systems
  • (Oxfam 2009,
  • Nishtar 2010)

Costs of care for users

  • Development of tool for policy mapping and gap analysis of policy design (relative to target) and implementation (relative to design)
  • Pilot study in two states in India

Quality of care

Delhi

MP

Conduct of providers

Accessibility of care

series building the field of health policy systems research
Series: building the field of Health policy & systems research

Sheikh, Gilson, Bennett, others (2011)

Commissioned by PLoS Medicine

subjects of enquiry in h p sr the dominant perspective
Subjects of enquiry in H(P)SR: the dominant perspective

SYSTEMS FUNCTIONS

  • Systems defined on basis of their utility, problems mainly relate to efficiency
  • Decisions are concentrated, flow in one direction
  • Policy content not problematized

E.g. WHO ‘building blocks’

Policy Decisions

Systems

Human Resources, Finance, Medicines & technology, Organizational structure, Service infrastructure, Information systems

Outputs

Outcomes

framing the field a broad church
Framing the Field: a broad church

COMPLEX AND SOCIALLY CONSTRUCTED

  • Decisions are diffused, relationships are non-linear
  • ‘Software’ critical to health systems performance
  • Problems (and solutions) are related to (understanding) complexity
  • Shaped by particular politics, culture, discourse (and not others)
  • Solutions within and beyond health systems

(e.g. Frenk 1994, de Savigny and Adam 2009, Lambert 2006, Illich 1970)

SOCIAL AND POLITICAL CONTEXT

ARENA

Policy Decisions

International

National

Subnational

Local

Systems ‘Hardware’

Human Resources, Finance, Medicines & technology, Organizational structure, Service infrastructure, Information systems

Systems ‘Software’

Ideas and interests, Relationships and power, Values and norms

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